Provider Demographics
NPI:1033645544
Name:MOSHER, JOSEPH (MED, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MOSHER
Suffix:
Gender:M
Credentials:MED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 WHITTIER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1028
Mailing Address - Country:US
Mailing Address - Phone:845-392-5824
Mailing Address - Fax:
Practice Address - Street 1:1905 WHITTIER AVE NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1028
Practice Address - Country:US
Practice Address - Phone:845-392-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0029562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer